The compounding pharmacy sector overwhelmingly refuses to supply drugs for lethal injection. This aligns with their mission to provide customized medicines that heal, not harm —and avoids significant legal, financial, and reputational risks.

Yet as states face mounting challenges acquiring drugs for executions due to opposition from the pharmaceutical industry, some have sought to turn to compounders as an alternative source.

Of the thousands of compounders across America, only a small handful have been willing to prepare drugs for executions. Each time one of those compounders has been identified publicly, they have been linked to other serious safety and regulatory violations.

These practices risk casting a shadow over the industry as a whole, threatening to erode public trust by associating compounders with a practice the vast majority of its members reject.

This page outlines the risks involved when states seek out compounded medicines for executions, and offers guidance to help safeguard the compounding profession.

Background: Professional Association Opposition
There is consensus among compounders and the wider profession of pharmacists that participation in, or otherwise facilitating, executions is incompatible with medical ethics.

  • The Alliance for Pharmacy Compounding (APC) has issued a formal position discouraging the preparation, dispensing, or distribution of compounded drugs for executions.
  • The American Pharmacists Association (APhA) recommends that pharmacists should not be involved in executions “on the basis that such activities are fundamentally contrary to the role of pharmacists as providers of health care.”

1. Legal and Regulatory Exposure

Compounding drugs for executions risks breaking state and federal regulations.

  1. Lethal injection protocols often involve Schedule II controlled substances (e.g., Pentobarbital, Fentanyl, Hydromorphone) subject to strict federal regulations.
  2. Pharmacists who compound and dispense these drugs without a valid medical prescription may violate state and federal law, including the Food, Drug, and Cosmetic Act (FDCA) and the Controlled Substances Act (CSA).
  3. Active ingredients for many execution drugs are not available domestically. Compounders may be unknowingly procuring ingredients on the black-market.
  4. Supplying drugs for lethal injection executions increases a pharmacy’s risk of :
    – high profile state investigations;
    – financial losses;
    – regulatory action;
    – media scrutiny; and
    – legal action (including product liability actions and tort claims).

2. Reputational Risk and Public Scrutiny

The pharmacies that secretly supply execution drugs are often eventually identified publicly.
Executions, particularly those that are botched—a frequent occurrence because these drugs were never meant to be used for executions—receive intense media and political attention.

A pharmacy’s association with the harm caused to both prisoners and the broader patient population can seriously damage its credibility, a fact that has been noted in recent Congressional letters to the FDA and DEA. For example:

  • A pharmacy that secretly supplied the Texas Department of Criminal Justice with execution drugs over many years was later prohibited by the DEA from dealing in controlled substances following a series of violations, including causing the death of a patient by Fentanyl.
  • A pharmacy that secretly supplied the Missouri Department of Corrections with execution drugs was revealed to have had 1,892 violations of pharmacy regulations. The FDA warned that the pharmacy’s conduct “could lead to contamination of drugs, potentially putting patients at risk.”
  • Another pharmacy compounding Pentobarbital, an emerging drug of abuse, for use in executions was cited by state and federal officials for scores of safety violations, in one case sending a child to the hospital after compounding the wrong drug.

3. Insurance Risks

Insurers are increasingly alert to the legal and reputational exposures associated with execution-related compounding.

  • Professional and general liability insurance may exclude coverage for claims related to executions.
  • Some insurers are now including questions for applicants that require disclosure of potential involvement in execution drug compounding—and may deny coverage if such activity exists.
  • The International Academy of Compounding Pharmacists (now APC) has warned members about these risks, questioned the legality of providing drugs for executions, and raised concerns about lack of insurance protection.

Recommended Actions for Compounders

To protect your practice and uphold professional standards:

  • Decline requests to compound drugs for executions, in line with the policies of pharmacy professional associations.
  • Review insurance policies for relevant exclusions.
  • Understand federal and state laws connected to any execution-related compounding.
  • Clearly communicate your policy if approached by correctional authorities.

While the issue of lethal injection is complex and politically charged, the compounding profession must prioritize public trust, patient care and professional ethics.

By maintaining a clear stance and equipping compounders with the tools to navigate this issue, the industry can continue to demonstrate its dedication to the highest standards of pharmacy practice.